Information Collection

Employee Claim for Wage Restitution

IC 182985 under ICR 201102-1600-002 · OMB 1600-0002.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1600-0002 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DHS 700-4 Employee Claim for Wage Restitution	Form
DHS 700-4 Employee Claim for Wage Restitution DHS Form 700-4.pdf	Form

IC Title:

Employee Claim for Wage Restitution

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DHS 700-4	Employee Claim for Wage Restitution	DHS Form 700-4.pdf		Yes	No	Fillable Printable

Line of Business: Supply Chain Management

Subfunction: Services Acquisition

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 31

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	31	6	25
Annual IC Time Burden (Hours)	31	6	25
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.